The Role of Six Anthropometric Indicators in Predicting the Prevalence and Mortality of Obstructive Sleep Apnoea, Asthma, and Chronic Obstructive Pulmonary Disease: A Population- Based Study from the US National Health and Nutrition Examination Survey (NHANES)

Background: Obesity is linked to a greaterrisk of respiratory diseases. Due to limitations in body mass index (BMI), alternative anthropometric indicators have been developed to reflect body fat distribution. This study compares six anthropometric measures—BMI, waist circumference(WC), the waist-to-height ratio(WHtR), the body roundness index (BRI), the body shape index(ABSI), and the weight-adjusted waist index (WWI)—and their relationships withthe prevalence and mortality of obstructive sleep apnoea (OSA), asthma, and chronic obstructive pulmonary disease (COPD) in the US population. Methods : Data from four NHANES cycles were analysed. Multivariable logistic regression assessedthe cross-sectional associations between the six anthropometric measures and disease prevalence. Mortality associations were analysed via Cox proportional hazards models, and time‒dependent ROC curve was utilised to evaluate the predictive performance of the significant marker for mortality. Results : BMI, WC, WWI, BRI, ABSI, and WHtR were positively correlated with the prevalence of OSA, and COPD. For asthma, BMI, WC, BRI, and WHtR were positively associated with prevalence, while ABSI and WWI were negatively associated. Concerningmortality, higher WC and BMI were associated with better survival in the OSA and COPD groups, whereas elevated WWI and ABSI were linked to greater mortality risk in the participants with OSA symptoms. An increase of one standard deviation (SD) in the ABSI resulted in an 18% increase in mortality (95% CI: 1.09-1.27) for the OSA population. The area under the curve (AUC) for ABSI was 0.752 for 3-year, 0.755 for 5-year, and 0.744 for 10-year mortality. Conclusions : Novel anthropometric indicators, including WWI, BRI, ABSI and WHtR, show positive associations with the prevalence of OSA, and COPD, alongside traditional measures likeBMI and WC. However, WWI and ABSI were more limited in their association with asthma prevalence. Longitudinal analyses revealed that traditional anthropometric indicators such as BMI and WC were negatively associated with mortality risks in the OSA and COPD, supporting the "obesity paradox." ABSI, however, emerged as a significant mortality predictor for OSA, providing a more nuanced view of central obesity’s impact on mortality. However, in COPD patients, routine anthropometric measurements may not fully capture the effects of obesity.